Treatment of Distal Radius Fracture During Immobilization with an Orthopedic Cast: A Double-Blinded Randomized Controlled Trial of Photobiomodulation Therapy.

ABSTRACT

Objective: With distal radius fracture (DRF) many patients experience stiffness and pain after removal of the cast. The aim of this study was to investigate possible effects of photobiomodulation therapy (PBMT) in DRF during immobilization with semicircular orthopedic cast. Methods: In this double-blinded, placebo-controlled trial, 53 patients with DRF were randomized to receive nine treatments of either PBMT or placebo-PBMT. The fractures were irradiated through openings in the cast. Patient-Rated Wrist and Hand Evaluation (PRWHE) questionnaire and clinical outcomes were measured at baseline, 4, 8, 12, and 26 weeks after the trauma. Results: No significant differences were found for PRWHE scores, although PBMT was significantly superior to placebo regarding active range of motion [AROM; 95% (confidence interval) CI -65.25° to -20.42° and -25.57° to -0.73°, respectively] and grip strength at week 4 (95% CI -12.10 to -1.67 kg). Side-to-side differences between injured and noninjured wrists were significantly smaller in the PBMT group regarding grip and pinch strength at week 4 (95% CI 0.89 to 8.87 kg and 0.55 to 3.79 kg, respectively). Significantly less patients in the PBMT group reported night pain at week 3. Conclusions: PBMT administered during the immobilization period of DRF had no effect on perceived pain and function measured through PRWHE. Night pain was significantly reduced after 3 weeks by PBMT. PBMT significantly improved pinch and grip strength and AROM, but these findings did not translate to the subjective experience of pain and function. Trial registration number Clinical.trials.gov number NCT02749929. The study was approved by the Regional ethics committee (REK-Vest) in Norway (App. No 2015/330). Informed consent was obtained from all patients.